Degenerative Disc Disease Treatment Goals
The vast majority of people with degenerative disc disease experience low back pain symptoms that flare up periodically, but do not get worse over time. For those people, the main goals for managing lower back pain caused by degenerative disc disease are usually:
- Achieving enough pain relief to be able to engage in lower back pain exercises and a rehabilitation program
- Trying to manage the low back pain and maintaining an ability to function at home and at work.
Once a disc has degenerated, the degenerative process cannot be reversed. Instead of trying to rehabilitate the disc itself, treatment focuses on improving the health of surrounding structures, such as the spinal nerves, vertebral bones and joints, and supporting muscles and ligaments.
The main goals of the rehabilitation program include a therapist-guided and individual approach, which aim to2:
- Increase, restore, and/or maintain the range of motion in the affected spinal segment
- Build physical strength, flexibility, coordination, balance, and endurance in the lower back and legs
- Guide patients to make ergonomic changes in their workspace and home to support the spine and prevent recurrence of pain
- Teach the correct use of posture while sitting, walking, sleeping, and lifting to promote maximum function with lesser pain
What Is The Outlook
Most of us will have a bout of nonspecific low back pain at some point in our lives. The severity can vary. However, it is difficult to quote exact figures as to outlook . This is partly because it is so common and many people with back pain do not consult a doctor. Roughly, it is thought that:
- Most nonspecific back pains ease and go quickly, usually within a few weeks.
- In about 4 in 10 cases, the pain has completely gone within four weeks.
- In about 7 in 10 cases the pain has completely gone within one year.
However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain.
Maintain Correct Posture During Activities
To protect your lower back from injury, its important to maintain proper posture when performing physical activitiesespecially if you play sports or have a job that requires repetitive motions. Avoid slouching as much as possible and aim to keep your spine erect. When lifting, bend and straighten from the knees, not the waist. And be sure to move your hips when twisting from side to side.
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Chronic Conditions That Cause Back Pain
Conditions that can lead to chronic low back pain include spinal stenosis, spondylitis, and fibromyalgia. Spinal stenosis is narrowing of the normal spinal canal through which the spinal cord passes. Spondylitis is chronic inflammation of the spine. Fibromyalgia is a muscle disorder that features chronic muscle pain and tenderness.
Low Back Pain Treatment
Epidural Steroid Injection
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back causes pain that goes down the leg. Epidural injections are also used to treat nerve compression in the neck , referred to as cervical radiculopathy, which causes pain.
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More Advanced Care Options
Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:
Implanted nerve stimulators
- Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
- Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
- Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.
Should I See A Chiropractor For My Back Pain
Spinal manipulation is used by chiropractors and osteopathic physicians to treat low back pain in selected patients. Spinal manipulation applies hand pressure to areas of the low back to relax irritated muscle and lessen the intensity of the pain.
Traction, using pulleys and weights to lengthen and stretch the spine can result in temporary relief. Both techniques will not treat any underlying causes of back pain, but rather offer a temporary relief from lower back pain.
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Support Your Body In A Warm Pool
The buoyancy of the water lets you enjoy the benefits of exercise with less pain. Exercising in water also helps regulate the functioning of nerves and muscles, relieving pain.14
If you prefer warmer pools, look into water exercise classes and hydrotherapy pools. Water therapy exercises are often done in water that is about 83 degrees to 88 degrees. Hydrotherapy pool temperatures are often more than 90 degrees.
% Of People Will Experience Back Pain At Some Time But There Are Ways To Find Relief
As people enter middle age, they are more likely to experience bouts of low back pain. In fact, according to the Harvard Special Health Report Men’s Health: Fifty and Forward, back pain affects about four in five Americans at some point in their lives and equally strikes men and women.
Age is often the culprit. Over time, the bones and joints in your lower back begin to change. Your discs tend to wear out and sometimes become fragmented. These structural alterations sometimes cause pain.
Another cause of low back pain, although it occurs less often, is a herniated disc. Sometimes, a disc pushes outside the space between the bones and compresses a nerve at the point where it branches off the spinal cord. When the sciatic nerve that leads into the buttocks and leg is affected, the pain is called sciatica.
Yet, most cases of low back pain stem from strain or sprain due to simple overuse, unaccustomed activity, excessive lifting, or an accident. In most cases the best move is to wait and see if the pain resolves on its own. If the pain does not improve after three to four days, then it’s time to see a doctor.
However, depending on the source of your back pain and its severity, you might try a few home remedies for low back pain to help ease the pain until your back returns to normal. Here are several options to consider:
Complementary therapies. Several types of complementary therapy may be helpful for relief from low back pain. These include:
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When Can I Return To Work
Its usually recommend that you return to work right away. If you cannot do your regular job, it is in your best interest to return to some kind of modified duty . Your healthcare provider can give you a prescription for a limited period of modified work duty.
It is very common to be afraid to promptly return to work and other activities because of fear of re-injury. However, if you are receiving proper treatment, your risk of re-injury should be limited. It is in your best interest to return to a normal lifestyle promptly. Early mobility has been found to directly result in a more rapid recovery. Maintaining a positive mental attitude is also imperative to a quick recovery.
Last reviewed by a Cleveland Clinic medical professional on 12/22/2020.
How Is Back Pain Diagnosed
A careful evaluation of your medical history and a physical examination will help your healthcare provider determine if you have mechanical back pain. He or she will then work with you to create an appropriate treatment plan.
If your healthcare provider has determined your back pain is mechanical, additional testing is not usually necessary. If your symptoms or the examination suggest the possibility of infection, malignancy, or a pinched nerve, additional tests may be done. Additional testing may include blood tests, x-rays, computed tomography scan, magnetic resonance imaging and/or nerve conduction studies.
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Example Progression Of Treatment Regimens For Lumbar Degenerative Disc Disease
Treatments need to be individualized. However, as a general rule, lumbar degenerative disc disease treatments start with basic pain control and non-invasive treatments and progress, if needed, to more extensive and/or invasive treatments.
One example of how treatment approaches may progress over time would be:
- Bed rest, or reduced activity, for the first 1 to 2 days after onset of severe pain, combined with anti-inflammatory medication such as ibuprofen, and ice and/or heat therapy
- Prescription muscle relaxant medications, as needed, for up to 1 week
- Gentle stretching and aerobic exercise, for at least 3 times a week
- Physical therapy if after 3 weeks there is no improvement in pain
- An epidural injection if after 3 to 6 weeks there is little to no improvement in pain
- Spinal surgery if after 6 to 12 months the pain is severe, ongoing and significantly limits daily activities
Bed rest beyond the first 2 days of sharp, severe pain is not usually advised, because regular movement improves blood circulation and muscle strength and helps the body to heal more quickly than bed rest.
The above is just one example of a typical progression of treatments, and additional therapies or a different type of progression of care is not uncommon based on the patientâs condition and the treating physicianâs preferences as well as other variables.
Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
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Massage Therapy For Low Back Pain
Studies have shown that massage treatments can help relieve chronic low back pain. Massage treatment can restore people to their usual activities of daily living and lessen pain. Massage therapy is limited, and would not be the most effective solution for patients with spinal complications, injuries, or disk problems since massage focuses on the release of muscle tension and not on the structure of the spine itself.
How Do Health Care Professionals Diagnose Lower Back Pain
The diagnosis of low back pain involves a review of the history of the illness and underlying medical conditions as well as a physical examination. A complete story of the back pain must be reviewed including injury history, aggravating and alleviating conditions, associated pain symptoms , as well as the duration and progression of symptoms. Aside from routine abdomen and extremity evaluations, rectal and pelvic examinations may eventually be required as well. Further tests for diagnosis of low back pain can be required including blood and urine tests, plain film X-ray tests, CAT scanning, MRI scanning, bone scanning, and tests of the nerves such as electromyograms and nerve conduction velocities .
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How To Relieve Back Pain
The following tips may help reduce your back pain and speed up your recovery:
- stay as active as possible and try to continue your daily activities this is 1 of the most important things you can do, as resting for long periods is likely to make the pain worse
- try exercises and stretches for back pain other activities such as walking, swimming, yoga and pilates may also be helpful
- take anti-inflammatory painkillers, such as ibuprofen remember to check the medicine is safe for you to take and ask a pharmacist if you’re not sure
- use hot or cold compression packs for short-term relief you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well
Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.
Back pain usually gets better on its own within a few weeks or months and you may not need to see a doctor or other healthcare professional.
But it’s a good idea to get help if:
- the pain does not start to improve within a few weeks
- the pain stops you doing your day-to-day activities
- the pain is very severe or gets worse over time
- you’re worried about the pain or struggling to cope
If you see a GP they will ask about your symptoms, examine your back and discuss possible treatments.
They may refer you to a specialist doctor or a physiotherapist for further help.
Pinpointing The Source Of Low
How we treat back pain depends on its cause. It was long thought that low-back pain was largely due to trouble in the discs, the cushions that separate each of the spines bones from each other.
Today we know that low-back pain can also originate inside the vertebrae specifically from the nerves in the vertebral endplates, where the bone meets the discs. Just like other parts of the body, the vertebral endplates are vulnerable to deterioration and nerve damage. Nerves carry the messages between your body and brain that help you feel sensations, including pain.
This is known as vertebrogenic low-back pain, and it was designated as an official diagnosis with an International Classification of Diseases code in October 2021.
While anti-inflammatory medications, physical therapy, or cortisone injections can help some patients, conservative treatments are not always effective for vertebrogenic low-back pain. Fortunately, we now have this new, highly effective procedure to offer our patients.
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Remedies To Relieve Lower Back Pain Fast
We all want to know the best way to relieve lower back pain fast. At best, backache can be frustrating, perhaps draining. At its worst, this kind of discomfort can be utterly debilitating. If you have ever awakened with a terrible backache, you may have also learned how quickly such an ailment can derail your day, your week, or even several months or years.
Fortunately, there are remedies to combat that ache. From exercising to getting better sleep to reducing your stress levels, you can choose from a variety of strategies. The next time you have a backache , consider the following methods of back pain relief. Remember to discuss at-home back pain remedies with your doctor before you make use of them.
Can I Prevent Lower Back Pain
You cant prevent lower back pain that results from disease or structural problems in the spine. But you can avoid injuries that cause back pain.
To reduce your risk of a back injury, you should:
- Maintain a healthy weight: Excess weight puts pressure on vertebrae and disks.
- Strengthen your abdominal muscles: Pilates and other exercise programs strengthen core muscles that support the spine.
- Lift the right way: To avoid injuries, lift with your legs . Hold heavy items close to your body. Try not to twist your torso while youre lifting.
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Team Approach To Pain Management
For some, an integrated team of specialists may be best suited to manage the chronic lower back pain from degenerative disc disease. A team will usually comprise some combination of the following health professionals:
- A pain management specialist, such as a physical medicine and rehabilitation physician or anesthesiologist focused on pain management
- A physical therapist or physiatrist focused on rehabilitation
- A psychologist and/or psychiatrist for co-existing mental health issues, such as depression and/or difficulty sleeping
- An occupational therapist to assist with functional rehabilitation
In addition, a specialized nurse case manager or another health professional may work with the team to coordinate the care needed to treat depression, disability, and chronic pain.
Sometimes the combination of treatments is more effective than individual treatments. For example, the use of cognitive behavioral therapy has been shown to improve the benefits of physical therapy3 and reduce sleep problems.
Will Bed Rest Help Back Pain
Doctors often recommend continuing your usual activities of daily living as soon as possible. Studies suggest that strict bedrest can often prolong or worsen low back pain. Bed rest can also lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. You should try and keep moving while avoiding activities that noticeably aggravate or worsen back pain. By staying active, those who suffer from low back pain can gain greater flexibility and quicker recovery.
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